Tumor load in lymph node positive melanoma: Classification systems, prognostication models and management recommendations

Abstract

The incidence and mortality of melanoma, the most malignant type of skin cancer, is increasing worldwide. The sentinel node procedure is accepted as a diagnostic procedure for patients with primary melanoma > 1mm. The prognosis of the group of sentinel node-positive patients (20-30 % of the total group) is very heterogeneous and depends on, amongst others, the maximum tumor size and the intranodal tumor location. Patients with sentinel node metastases less than 0.1 mm have a survival rate which is similar to sentinel node-negative patients, especially when the metastases are located subcapsularly only. Completion lymph node dissection and its high morbidity can be spared in these patients. For patients with palpable nodal melanoma disease a therapeutic lymph node dissection is indicated. In conclusion, surgery will remain important in the management of malignant melanoma.